HomeMy WebLinkAboutBuilding Permit Application f
All APPLICABLE INFO
��M11U��ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'r3'w• I Qj , Permit Number: Jq 0 )—0 Q�1
RECEPIED
Building Permit.Application JAN 2 4 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division g p
2300 Virginia Avenue,Fort Pierce FL 34982 St..Lucie County, FL
Phone: (772).462-1553 Fax: (772)462-1578 . Commercial R
PERMIT TYPE: �� m 6 r C' i a�-
PR• 'USED IN' QUEMEN LtOGATIQN:
Address: z11 by
Property Tax ID#: q 2 - ^oo®U ex-O Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED i@So.a,IPAT,I I• O ORK:
. Chi 4-3
C+ STRUCTlO L 'FO'RMAT UN:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas!P'i'ping Shutters - _Windows/Doors .:
Electric _.Plumbing —Sprinklers —Generator. - _,Roof, 'Pitch-
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ��� Utilities: —Sewer ._Septic Building Height:
• FIRf LE�S� E CONTRA TOR.
Name C 6.0G 5L-SGcis 106 ,*t. Name: . 114bov , ccs
Address: ��UG' lair cFP�6, Q� Company: '
City: State: r- Address: 921 s1v 31 S
Zip Code: Fax: City: Pn1i�q C I State:,.r�
Phone No. 772 WO /5-30 Zip Code: 9- M(.) Fax:
E-Mail: Phone No e-107 Ak) 2 3 7,
Fill in fee simple Title Holder on next page(if different E-Mail �'t,t f Co 2Y 7 dfiv) Cork-
from the Owner listed above) State or County License ,fp f IySr`�S�/Sr
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
S PPLEMNTA,LONSTR 'CTION IE�N 1NFURMAT • '
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: 1 =,': Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to'do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
-St.Lucie County makes no representation that is granting a permit will authorize-the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules;bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. .
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OW ER.,Your failure to Record a Notice of Commencement may result in your paying twice for
improvements t your property. A Notice of Commencement must be recorded and posted on the obsite
before the first i spection. If you intend to obtain financing, consult with lender or an attorney b�fo're'== `.
commencingwor 'or�'recordin our Notice encement. N
ti; U `
_ R
111
N
Signature of O ner Less a 'Contractor as Agent fo ��",,�,gr- Signature of Contractor/License Holder v� a
` O�
�¢t
[a to.. :° '-
STATE OF FLORI �� Z STATE OF FLORIDA ¢�X
COUNTY OF s�� 2 COUNTY OF �W
rw - `* ro®
The forgoing instrument was acknowledge�efore e m The forgoing ins t was acknowledged befo irA.e'''•�,
this�/t day of 20� by �;.�oti this of 20_ by
off' '.� *•1�,rr
Ic
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id it i tion Type of Ide�fii#i ti n ) n
Produced (_ Produced i
(Si ature.of No Public-State of Florida) (Signature of Not Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER- REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R-e—v. 9/26/18